Apply Online

Thank you for visiting us and welcome to our online enrollment application for the CSA Early Head Start Infant & Toddler Care and Head Start Preschool Programs! Please complete the following sections to the best of your ability. We will use this information to help determine your family’s eligibility for services.

Please do not hesitate to contact us at (775) 786-6023 or enrollment@csareno.org if you have any questions or need help completing the form.

If you have applied for our program previously, you may receive a duplicate message. This means your family information is already in our system and we will need to update your application by phone. If this is the case, please proceed here: Returning Family Application.

Please complete this section for the parent/guardian of the child(ren) applying for the program.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Birthday (Required)

Gender (Required)

Email Address (Required)

Confirm Email Address

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Mobile Phone

Opt In for Text Messages

Home Phone

Work Phone

Ext.

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Race (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Lives with Family (Required)

Provides Financial Support (Required)

Teen Parent

Who Referred You? (Required)

If your mailing address is different from your living address, please be sure to un-check the Mailing Address same as Living Address box below. If your mailing address is the same, leave the box checked.

Is your family currently experiencing a temporary living situation because housing was lost due to loss of employment/income, financial/economic hardship, or similar reasons? If yes, select yes to the following question.

Is your family experiencing homelessness?

Living Address (Required)

Address Line 2

City (Required)

State (Required)

ZIP (Required)

Click here to find a provider in your area.

Mailing Address same as Living Address

Mailing Address

Address Line 2

City

State

ZIP

Please only add an Additional Parent/Guardian if they are living in the same home AND related to any of the child applicants by blood, marriage, adoption, or guardianship. Do not list parents/guardians who are not living in the home.

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Birthday (Required)

Gender (Required)

Email Address (Required)

Confirm Email Address

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Mobile Phone

Opt In for Text Messages

Home Phone

Work Phone

Ext.

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Race (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Lives with Family (Required)

Provides Financial Support (Required)

Teen Parent

Are there other adults in the household?

Add Another Adult

Please complete all fields in this section. This information helps us to better document your family’s program eligibility which is based on family income and family size. Add all members living in your household who are related to you and the other parent/guardian by blood, marriage, adoption, or guardianship AND who are supported by your incomes.

In the Number of Parents/Guardians box, select Two Parent Family if you added 2 parent/guardians to this form. If your household does not have an additional parent/guardian, select One Parent Family.

Number of Parents/Guardians (Required)

Relationship to Participant(s) (Required)

Primary Language at Home (Required)

Is another language being acquired or learned at home?

Number in Household

Number in Family

Gross Annual Income

Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program? (Required)

Is your family receiving Supplemental Security Income (SSI)? (Required)

Is your family receiving services from WIC? (Required)

Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps? (Required)

Is at least one parent/guardian an active duty member of the United States military? (Required)

Is at least one parent/guardian a veteran of the United States military? (Required)

Add Emergency Contact

Use this section to add all children you would like to enroll in the Early Head Start Infant & Toddler Care or Head Start Preschool Program.

Please be sure to let us know of any concerns or additional information you feel we should be aware of for each applicant in the space Is there anything else you want to tell us about your child? This could be about vision, hearing, speech/language, developmental delays, behavioral concerns, if there is an IEP or IFSP, special family circumstances, etc.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Birthday (Required)

Gender (Required)

Race (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Primary Health Coverage (Required)

Other Coverage

Doctor/Medical Home (Required)

Dental Coverage

Dentist/Dental Home (Required)

Does your child have a disability or do you have any concerns about your child's development? (Required)

Is there anything else you want to tell us about your child?

Which program are you applying for? (Required)

Location Preference

1st Location Preference

2nd Location Preference

3rd Location Preference

- Your Address - Available Locations

Click a location on the map to see more info

Click here to find a provider in your area.

Do you want to apply now for another child in your family?

Add Another Applicant

Are there other children in the family?

Add a Sibling

I hereby declare that the information contained in this application for program services is true and correct to the best of my knowledge and understanding. No false or misleading statements have been made by me or anyone representing me. The acceptance of the application DOES NOT guarantee that services will be performed under any program, and that services are dependent on many things including accurate applications, availability of funding and determination that the applicant qualifies for the program.

I hereby release, discharge, and exonerate Community Services Agency, their agents and representatives and any person furnishing information or examining information from any and all liability of every nature and kind arising out of the furnishing and inspection of such documents, records and other information, and this release shall be binding on my legal representatives, heirs and assigns. I additionally authorize Community Services Agency and their agents and representatives to use the information that I have provided and aggregated with other customers and clients of Community Services Agency for any and all reporting and funding purposes.

Community Services Agency, its agents, partners and funding sources do not discriminate based on color, sex, age, religion, national origin, disability, marital status, sexual orientation, ancestry, or any other consideration made unlawful by the applicable discrimination laws. The USDA is an equal opportunity provider and employer.

By clicking submit below, you state you understand the above notice and you will receive a confirmation e-mail. A member from our enrollment office will be in contact with you shortly. Thank you for completing the enrollment application!

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Emergency Contacts

Child (Applicant)

Location Preferences

Additional Applicant

Siblings